What is the Treatment for Orbital Fracture and its Healing Time?

Reviewed By: Pramod Kerkar, MD, FFARCSI

The human eye is surrounded and protected by a bony cup, which is known as the eye socket. Thick bones form the rim of the socket. However, the nasal side and the floor of the socket is paper thin in many regions. Orbital fracture is a breakage in the bone in the eye socket, which can involve the rim, the floor or even both.

Treatment for Orbital Fracture comprises of surgery in severe cases and ice packs, rest and antibiotics in mild fractures.

Types of Orbital Fracture

Orbital Rim Fracture: These occur as a result of direct impact to the face, often in car crashes from the face being hit into the steering wheel or an automobile dashboard. These fractures occur due to a huge amount of force, and because of this force, patient also experiences extensive injuries to other facial bones, and sometimes even injuries to the brain. There also may be injuries to the eye, such as damage to the optic nerve, eye muscles, injury to the nerves which provide sensation in the cheek and forehead, damage to the sinuses surrounding the eye and the tear duct.

Orbital rim fractures are of two types: The first one is a zygomatic fracture which occurs in the lower edge of the eye rim and in also a part of the cheekbone. Second one is frontal sinus fracture or frontal bone fracture which occurs in the upper edge of the eye rim and is also a part of the frontal bone of the forehead.

Orbital Blowout Fracture or Indirect Orbital Floor Fracture: This is a fracture of the paper thin floor of the eye socket with the bony rim surrounding the eye remaining intact. The floor of the eye socket ruptures or cracks resulting in a small hole in the eye socket’s floor which can trap some parts of the eye muscles and its surrounding structures. This causes aberration in the eye movements resulting in double vision. Blowout fractures commonly occur as a result of impact to the anterior part of the eye from something which is bigger than the eye opening. It could be anything such as a fist, baseball, or dashboard of the automobile.

Direct Orbital Floor Fracture: This is where the fracture to the orbital rim extends into the adjacent parts of the floor of the eye socket and there is fracture of the both the rim and the socket floor.

Causes of Orbital Fracture

Majority of the eye injuries occur by accident, in car crashes, at work, during contact sports, or when doing repair projects at home. Some of the eye injuries occur as a result of violent assaults. Men are four times likely to suffer from traumatic eye injuries than women. Average age of the person at the time of injury is usually 30. The source of the eye injury is commonly blunt object such as hammer, baseball, piece of lumber or rock. Majority of these injuries occur at home, as due to the advent of airbags and strict rule of using seatbelts in the cars, the eye injuries occurring in the cars from the victim's face striking into the dashboard have decreased.

Signs & Symptoms of Orbital Fracture

Symptoms of Orbital Fracture depend on the severity and location of the fracture and comprise of:

There is swelling and black and blue discoloration around the injured eye due to fracture orbital bone.

There also may be redness and patches of bleeding on the sclera (the white part) of the eye and on the eyelids’ inner lining.

Orbital Fracture causes difficulty in eye movements, such as looking up, down, right or left.

There is numbness in the eyelids, forehead, cheek, upper lip or teeth and on the side of the eye injury. This can occur as a result of nerve damage due to the fracture.

There is abnormal position of the eye, such as the eye has either sunken in or is bulging out of the socket.

There is deformity and swelling of the forehead or cheek, with an obvious dent over the region of the broken bone.

If there is puffy accumulation of air beneath the skin near the eye, then it usually indicates that the fracture has broken the wall of the sinus cavity, maxillary sinus in particular, which is an air-filled chamber situated below the eye and inside the cheek.

Patient with Orbital Fracture may see flashing lights or "floaters" in the injured eye.

There may be cuts on the eyelid and on the internal surface of the eye.

Patient with Orbital Fracture has abnormally flat-appearing cheek, and there also may be severe pain in the cheek when the patient tries to open his/her mouth.

Investigations to Diagnose Orbital Fracture

If the patient is conscious, then the doctor will ask questions regarding the patient’s symptoms and the source and modality of the eye injury. The eye will be examined and the doctor will gently touch and press the cheek and forehead of the patient to look for distortion in these areas. Other than this, the doctor will also look for:

Whether the patient can move his/her eye or look upwards, downwards or sideways. If it is felt that one of the muscles of the eye has become trapped in the fracture site, then the doctor may grasp the tendon of the eye muscle and try to rotate the eye using his/her hand.

Internal damage to the eye is assessed using an ophthalmoscope. If there is any fracture of the eye socket then the diagnosis is confirmed using x-rays or CT scan of the region around the eye.

If the patient is not conscious and is suffering from severe facial injuries, then the diagnosis of an eye socket fracture is confirmed with x-rays and CT scan of the bones of the eye socket. This is done after any serious and life-threatening injuries have been attended and after the patient’s condition has stabilized.

Healing Time of Orbital Fracture

The healing time of orbital fracture depends on the severity and location of the fracture. In majority of the cases of orbital fracture, the discoloration and swelling begin to subside within a week to 10 days after the injury has occurred. However, the fractured orbital bones take a longer time to heal. If surgery is needed to repair the orbital fracture, then the doctor will wait for several weeks before operating, to allow the swelling to subside.

Treatment of Orbital Fracture

Treatment for Orbital Fracture depends on the location and severity of the eye injury.

If there is blowout fracture, which is small and uncomplicated, then only ice packs, decongestants and an antibiotic for preventing infection are prescribed. Patient is told to rest for some days and avoid blowing the nose and to allow the eye a chance to heal. Ice pack application helps in reducing the pain, swelling and discoloration due to Orbital Fracture.

In severe fracture of the orbital bone, the doctor will refer the patient to plastic and reconstructive surgeon with a specialty in treating eye injuries. An ophthalmologist needs to be consulted regarding the double vision and also to determine whether the patient needs surgery to repair the broken orbital bone or not.

Surgery for Orbital Fracture is done to remove fragments of the bone, free any entrapped eye muscles and to eliminate double vision.

In patients with Orbital Fracture, if the eye looks sunken in, then surgery will also help in restoring the normal architecture of the eye socket.

Surgery for Orbital Fracture is done to repair any eye rim deformities, which are also affecting the patient’s appearance.

Prognosis of Orbital Fracture

The prognosis for Orbital Fracture is good in most of the cases. There is a high success rate and low risk of long-term complications if the patient needs surgery to repair the fractured orbital bone.

Prevention of Orbital Fracture

Always wear protective eyewear when working. Goggles and face shields helps in cutting down the risk of eye injuries related to work by more than 90%.

Protective eyewear should also be worn when playing sports, such as baseball and basketball in which the maximum number of eye injuries occur.

Always wear a seat belt when driving or riding in a car, even if there are airbags in the car. Wearing seat belts and shoulder harnesses help not only in protecting the eyes, but also the facial bones and injuries to the upper body along with other injuries.